Stasis dermatitis: the hidden dangers of venous insufficiency

Stasis dermatitis (SD), also referred to as venous eczema or gravitational dermatitis, is a chronic inflammatory skin condition primarily affecting the lower extremities, particularly in older individuals with underlying chronic venous insufficiency (CVI). CVI leads to venous hypertension due to venous reflux, where the retrograde flow of blood in the veins results in increased pressure, causing damage to the skin and subcutaneous tissues. Clinically, SD presents with erythematous and eczematous plaques, often accompanied by symptoms like pruritus, scaling, dryness, and hyperpigmentation. The condition can worsen, leading to painful venous ulcers if left untreated.

The mainstay of treatment for SD is compression therapy, aimed at alleviating venous hypertension, swelling, and associated skin changes. Compression stockings and bandages are commonly prescribed to improve venous return and reduce symptoms. In cases where compression therapy is not sufficient, minor surgical interventions such as endovenous ablation or sclerotherapy may be performed to address the underlying venous reflux. Topical corticosteroids are often used to manage the inflammatory aspects of SD, providing relief from itching and eczema.

Despite the availability of these treatments, there is still a lack of approved therapies specifically targeting the cutaneous symptoms associated with SD. Newer approaches, such as topical phosphodiesterase 4 inhibitors, are under clinical investigation, highlighting the need for more effective treatments that directly target the inflammatory pathways involved in SD. As the population ages and the prevalence of CVI increases, the incidence of SD is expected to rise, underscoring the importance of early diagnosis and comprehensive management.